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Celebrating world mental health day with dignity in mind

Ahead of tomorrow’s World Mental Health Day, Dr Glenn Williams, Principal Lecturer in Psychological Therapies and Mental Health, blogs about this year’s theme of dignity in mental health and the steps being taken to reduce discrimination and stigmatisation.

On Saturday 10th October 2015 it is World Mental Health Day – a day that has been marked by the World Federation for Mental Health since 1992 to raise awareness to the general public worldwide about mental health issues.  Every year, there is a theme that focuses the activities for World Mental Health Day and this year the emphasis is on dignity in mental health.  The World Health Organization (WHO) has elaborated as to what dignity might mean and they define it as comprising: (1) freedom from violence and abuse, (2) freedom from discrimination, (3) autonomy and self-determination, (4) inclusion in community life, and (5) participation in policy-making.  The WHO has highlighted with a range of evidence about how the dignity of people facing mental health problems is often neglected.

Of all the mental health resources and services delivered throughout the world, approximately 90% are located and delivered within developed nations, but 80% of the world’s population is in the developing countries.  This mismatch is a continuing and ubiquitous problem and the WHO (2013) have continued to press for action to be put in place so that universal coverage of mental health and social care is available and appropriately delivered.  Societally, there are some challenges to be able to meet this aspiration because people’s mental health can sometimes be affected by structures in society that people do not ordinarily notice, namely cultural norms and dynamics that tend to treat difference as a state of ‘otherness’ that needs to be avoided or undermined at all costs  (Prilleltensky & Nelson, 2010).  Tackling mental health issues is not necessarily a case of it all being in the mind!

In fact, the dynamic of discrimination that has been thrust upon persons affected by mental illness goes back over centuries in which the afflicted person was deemed to have been subjected to demonic possession, given punishment for committing ‘sinful acts’, or worthy of avoidance for fear of catching some form of ‘contagion’.  In the late 1990s, the United Kingdom (UK) Government at the time released a National Service Framework for Mental Health in which the first Standard to be listed was the promotion of mental health for all and the combatting of discrimination against persons who are experiencing mental health problems.  Fast forward several years later, and surveys of the general population across several countries reveal that discrimination and perpetuation of myths about people with mental health problems are still endemic problems.  In one study (Wang & Lai, 2008), over 45% of a sample of 3,047 Canadian adults believed that people with depression were unpredictable and over 20% of the sample saw those with depression as dangerous.  This is not that different from a study (Crisp, et al. 2000) conducted with 1,700 UK adults, many of whom held beliefs that people with schizophrenia, alcoholism and drug addiction are unpredictable and dangerous. To compound matters, many in that sample of those surveyed were keen to attribute personal blame to those who were coping with addictions; moreover this same sample viewed people who had mental health issues as being difficult to talk to.  Clearly, prejudices about those facing mental health problems still persist. Although there is much to be said about allowing a person coping with mental health issues to be able to talk about their experiences, this is easier said than done.  Peter Etchells (2014) recently wrote about his concern in revealing his experiences of depression to others and his reluctance illustrates a type of stigma that could often go unnoticed – internalised stigma; this kind of stigma refers to negative attitudes that people can have about themselves.  In Etchell’s case, he was cautious about revealing his condition to others owing to it feeling inappropriate at the time but also with not wanting to come across as “that depressed guy”.  A study (Clement, et al. 2014) into stigma regarding mental health and avoidance of seeking help for mental health issues has shown that this kind of internalised stigma is one of the key barriers to enabling someone with a mental health problem to obtain the health that they might need.

For this year’s World Mental Health Day, the World Federation for Mental Health has provided a document to show how supporting the dignity of those experiencing mental health problems could come through legislation.  Authors of this document (Funk, et al. 2015) have argued that “Legislation can establish and enforce the basic requirement for human rights protection which can in turn lead to changes in ingrained attitudes and beliefs surrounding mental health” (p.14).  This is an encouraging ideal and the UK is fairly ahead of the game by having the Equality Act 2010 with which to emphasise this preservation of dignity for those affected by mental health issues.  However, legislation can only go so far.  Legislation could sometimes push certain prejudicial behaviours and attitudes underground…The same document also goes on to focus on the importance of “respect[ing] people’s autonomy, identity and dignity” (p.14).  Identity is crucial to a person coping effectively with a mental health issue and language can be pivotal to this. Language can imprison and it can empower.  Commonly, media representations of those experiencing mental health issues are ones that view the person involved as “suffering” from a mental illness.  By inferring suffering, the person concerned is already put into a victim-like state. The power of a diagnostic label can be empowering for some people but, in other contexts, it could be viewed as disempowering. For example, it is common practice in Alcoholics Anonymous meetings for members to identify as “I’m… [name of person] and I’m an alcoholic”, whereas others (e.g. Nowinski, 2014) have argued that alternative labels like seeing oneself as a “recovering alcoholic” could be more empowering and less stigmatising in such situations.

What is encouraging is that a lot has been done, and continues to be done, in terms of national and global campaigns to address the human rights of people who are dealing with mental health problems.  Campaigns by Mind, such as ‘Time to Change’, and work done by the Movember charity into the barriers that men may face in talking about mental health, are laudable schemes for keeping mental health in the public eye. They can go some way to reducing discrimination and tackling different forms of stigmatisation, including internalised stigma.  These initiatives can make it acceptable to talk about mental health issues in a variety of forums; in so doing, we may be able to effect a change nationwide in the workplace, places of worship, in schools, and many other social settings where we can embrace difference and help people through the emotional and mental challenges that they may be facing.  Globally, the WHO has estimated that approximately 450 million people are affected by mental health problems, whilst 1 in 4 British adults are diagnosed with at least one mental health problem in any one year (ITV.com, 2015).  This problem is not reducing in scale and, it is for this reason, we need to open our ears and listen to those who are affected and we need to be fully present for them so that they can get the help that they need.  After all, the “they” I have just been writing about might one day be you…

References:

Clement, S., et al. (2014). What is the impact of mental health-related stigma on help-seeking?: A systematic review of quantitative and qualitative studies. Psychological Medicine, 45 (1), 11-27.

Crisp, R. et al. (2000) Stigmatisation of people with mental illnesses.  British Journal of Psychiatry, 177, 4-7.

Etchells, P. (2014) Mental health stigma hasn’t gone away.  The Guardian.  28.8.2014. Available via: http://www.theguardian.com/science/head-quarters/2014/aug/28/mental-health-stigma-depression

ITV.com (2015) Key statistics: What you need to know about mental health.  Available via: http://www.itv.com/news/2015-07-27/mental-health-what-you-need-to-know/

Funk, M., et al. (2015) 2.1. Supporting dignity through mental health legislation.

Nowinski, J. (2014) ‘Recovering Alcoholic’: Words That Stigmatize or Empower? Available via:  http://www.huffingtonpost.com/joseph-nowinski-phd/addiction-and-recovery_b_4665947.html

Prilleltensky, I. & Nelson, G. (2010). Community psychology: In pursuit of liberation and well-being. (2nd Edition). New York, NY: Palgrave Macmillan.

Wang, J. & Lai, D. (2008) The relationship between mental health literacy, personal contacts and personal stigma against depression.  Journal of Affective Disorders, 110 (1), 191-196.

World Health Organization (WHO) (2013). The world health report: Research for universal health coverage.  Geneva: World Health Organization.

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Glenn Williams

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